Surgically Induced Contrast Enhancements on Intraoperative and Early Postoperative MRI Following High-Grade Glioma Surgery: A Systematic Review

Abstract

For the radiological assessment of resection of high-grade gliomas, a 72-h diagnostic window is recommended to limit surgically induced contrast enhancements. However, such enhancements may occur earlier than 72 h post-surgery. This systematic review aimed to assess the evidence on the timing of the postsurgical MRI. PubMed, Embase, Web of Science and Cochrane were searched following Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Only original research articles describing surgically induced contrast enhancements on MRI after resection for high-grade gliomas were included and analysed. The frequency of different contrast enhancement patterns on intraoperative MRI (iMRI) and early postoperative MRI (epMRI) was recorded. The search resulted in 1443 studies after removing duplicates, and a total of 12 studies were chosen for final review. Surgically induced contrast enhancements were reported at all time points after surgery, including on iMRI, but their type and frequency vary. Thin linear contrast enhancements were commonly found to be surgically induced and were less frequently recorded on postoperative days 1 and 2. This suggests that the optimal time to scan may be at or before this time. However, the evidence is limited, and higher-quality studies using larger and consecutively sampled populations are needed.

T1-Weighted Contrast Enhancement, Apparent Diffusion Coefficient, and Cerebral-Blood-Volume Changes after Glioblastoma Resection: MRI within 48 Hours vs. beyond 48 Hours

“…A recent systematic review found that CE changes may be best evaluated between 24 and 48 h after surgery, confirming the Updated Response Assessment Criteria for High-Grade Gliomas [ 18 , 19 ].…”

“…Only in recent years has attention been paid to Dynamic Susceptibility Contrast (DSC) sequences [ 19 , 20 , 21 , 22 ]. In pre-operative identification, the sensitivity and specificity of DSC appear to be high, at 94.7% and 93.7%, respectively, by the calculation of Cerebral Blood Volume (CBV) [ 23 ].…”

Recapitulating the Key Advances in the Diagnosis and Prognosis of High-Grade Gliomas: Second Half of 2021 Update

“…Rykkje and colleagues discussed the best timing for performing post-surgical MRI to evaluate the extent and effectiveness of surgical resection [ 46 ]. Increases in contrasts unrelated to the neoplastic tissues were observed at all times following surgery and even during surgery (intraoperative MRI).…”

Intraoperative MR Imaging during Glioma Resection

“…Several studies have reported thin linear new enhancements around the surgical margin seen during or immediately after surgery on T 1 -weighted images. 129 – 131 These anomalous enhancements are caused by disruption of the blood‒brain barrier or bleeding caused by surgical intervention or contrast leaking into the tumor cavity, and should not be confused with residual tumor. 132 The preoperative enhanced lesion and the intraoperatively and immediately postoperative occurring enhanced region must be carefully compared.…”